Dr Suleman AktaaSpecialty Trainee in CardiologyClinical Research FellowLeeds, UK

Quality Indicators

27 January 2020

#EORP@SulAktaa

• None

Declaration of Interest

The degree to which services increase the likelihood of desired outcomesand are consistent with current knowledge

Quality of Care

Lohr KN (ed.). National Academy Press, 1990

Quality of Care

Safety

EBM

Patient-centeredness

Timeliness of care

Equity

Efficiency

National Academies Press 2001

Framework to measure components of the quality of health care

Quality Indicators

Spertus JA, et al. Circulation. 2005;111:1703–12

Quality Indicator

Scientifically acceptable

Useable

Feasible (measurable)

Important

National Quality Forum

• Why to measure quality of care

• How to measure quality of care

• Challenges to overcome

Objectives

• Why to measure quality of care

• How to measure quality of care

• Where can we do better

Measure to Improve

T B Dondo et al. BMJ Open 2016;6:e011600

TR: 0.44, 95% CI: 0.41–0.45

Dondo T, et al. Eur Heart J Acute Cardiovasc Care. 2017;6:412–420

10

Jernberg T, et al. JAMA. 2011; 305: 1677-1684

N Engl J Med 2018; 379:948-957

Measure to improve

Quality of Care measurement

• Why to measure quality of care

• How to measure quality of care

• Where can we do better

Quality Indicators

Schiele F, Gale CP, et al. Eur Heart J Acute Cardiovasc Care. 2017 Feb; 6(1):34-59

Bebb O, et al. Eur Heart J. 2017;38(13):974–982.

Bebb O, et al. Eur Heart J. 2017;38(13):974–982.

QIs Development

Phase 1Identify domains and

dimension of care

Phase 2Literature & CPGs

Review

Phase 3Modified Delphi process

(patient involvement)

Phase 4External validation &

feasibility study

19

Modified from MacLean, et al. N Engl J Med 2018 378:1757-1761

QI selection

Modified Delphi Process

Inclusion Disagreement Exclusion

Normand SL, et al. Int J Qual Health Care 1998;10:247–260

QIs & OMs for AF

PROJECTSTART

JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN

Q1Systematic ReviewGuideline Review

Q2Consensus on QI/OM

(Delphi process)

Q3Manuscript Preparation

Q4Manuscript Review

and Submission

July, 18th

Working Group Launch

August, 30th

Common searchstrategy defined

September, 30th

Systematic review– QI-OM list

October, 31st

2-3 rounds of Delphi

November, 30th

QI & OM definedCase-mix definition

Manuscript Development

Early January1st Draft circulated

Document readyfor externalreview process

Feedback fromexternalreviewers

2nd Review submitted to Journal

Final submission to Journal

EP Journal Acceptance

QIs & OMs for AF

Quality Indicators

Measure to improve

Quality Indicators

• Why to measure quality of care

• How to measure quality of care

• Where can we do better

Quality Indicators

ESC Guidelines

Fanaroff A, et al. JAMA. 2019;321(11):1069-1080

House of Care.

Maren Batalden et al. BMJ Qual Saf 2016;25:509-517

Maren Batalden et al. BMJ Qual Saf 2016;25:509-517

“What is the matter with you?”

“What matters to you?”

Engaging Patients

31

Bhatt DL, et al. JACC. 2015;66(20):2230–45

QIs and Registries

33

Clinical Research

CPG

QIs recommended

Clinical Practice

QIs measured

EORP

Modified from Califf R, et al. J Am Coll Cardiol. 2002;40:1895–901

Feedback

Education

Collaboration Outcomes

Patient involvement

Thank you

s.aktaa@leeds.ac.uk